Method for bone reattachment

ABSTRACT

A method for trochanteric reattachment can include positioning a femoral prosthesis relative to a proximal portion of a femur. A first portion of a self-locking adjustable flexible member construct can be coupled to a first attachment region of the prosthesis, and a second portion of the self-locking adjustable flexible member construct can be coupled to a second attachment region of the femoral prosthesis, where the second portion can be opposite the first portion. A trochanter can be positioned relative to the femur and a trochanteric engaging region of the prosthesis, and the self-locking adjustable flexible member construct can be positioned around an outer surface of the trochanter. Free ends of the self-locking adjustable flexible member construct can be tensioned to draw the trochanter into secure engagement with the prosthesis and the femur via the self-locking adjustable flexible member construct in an absence of a knot.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/111,564 filed on May 19, 2011, which is a continuation-in-part ofU.S. patent application Ser. No. 12/938,902 filed on Nov. 3, 2010, whichis a continuation-in-part of U.S. patent application Ser. No. 12/915,962filed on Oct. 29, 2010, now U.S. Pat. No. 8,561,647 issued on Oct. 22,2013, which is a continuation-in-part of U.S. patent application Ser.No. 12/719,337 filed on Mar. 8, 2010, which is a continuation-in-part ofU.S. patent application Ser. No. 12/489,168 filed on Jun. 22, 2009, nowU.S. Pat. No. 8,361,113 issued on Jan. 29, 2013, which is acontinuation-in-part of U.S. patent application Ser. No. 12/474,802filed on May 29, 2009, now U.S. Pat. No. 8,088,130 issued on Jan. 3,2012, which is a continuation-in-part of (a) U.S. patent applicationSer. No. 12/196,405 filed on Aug. 22, 2008, now U.S. Pat. No. 8,128,658issued on Mar. 6, 2012; (b) U.S. patent application Ser. No. 12/196,407filed on Aug. 22, 2008, now U.S. Pat. No. 8,137,382 issued on Mar. 20,2012; (c) U.S. patent application Ser. No. 12/196,410 filed on Aug. 22,2008, now U.S. Pat. No. 8,118,836 issued on Feb. 21, 2012; and (d) U.S.patent application Ser. No. 11/541,506 filed on Sep. 29, 2006, which isnow U.S. Pat. No. 7,601,165 issued on Oct. 13, 2009.

This application is a continuation-in-part of U.S. patent applicationSer. No. 13/645,964 filed on Oct. 5, 2012, which is acontinuation-in-part of U.S. patent application Ser. No. 12/570,854filed on Sep. 30, 2009, now U.S. Pat. No. 8,303,604 issued on Nov. 6,2012, which is a continuation-in-part of U.S. patent application Ser.No. 12/014,399 filed on Jan. 15, 2008, now U.S. Pat. No. 7,909,851issued on Mar. 22, 2011, which is a continuation-in-part of U.S. patentapplication Ser. No. 11/347,661 filed on Feb. 3, 2006, which is now U.S.Pat. No. 7,749,250 issued on Jul. 6, 2010.

This application is a continuation-in-part of U.S. patent applicationSer. No. 12/702,067 filed on Feb. 8, 2010, which is a continuation ofU.S. patent application Ser. No. 11/541,505 filed on Sep. 29, 2006 andis now U.S. Pat. No. 7,658,751 issued on Feb. 9, 2010.

This application is a continuation-in-part of U.S. patent applicationSer. No. 13/098,927 filed on May 2, 2011, which is acontinuation-in-part of U.S. patent application Ser. No. 12/196,398filed Aug. 22, 2008, now U.S. Pat. No. 7,959,650 issued on Jun. 14,2011, which is a continuation-in-part of U.S. patent application Ser.No. 11/784,821 filed Apr. 10, 2007.

The disclosures of all of the above applications are incorporated byreference herein.

FIELD

The present disclosure relates generally to a method for securing afractured or resected bone, and more particularly to methods fortrochanteric reattachment.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

After trauma or surgical intervention, there may be a need to fix bonefragments or portions together to immobilize the fragments and permithealing. Compressive force can be applied to the bone fragments byencircling the bone fragments or bridging the fragments together acrossa broken, sectioned, resected or otherwise compromised portion of thebone. The compressive forces should be applied such that upon ingrowthof new bone, the fragments will heal together and restore strength tothe site of trauma or surgical intervention.

For example, in many reconstructive procedures of the hip, the greatertrochanter is often resected from the proximal femur and then retractedto permit the physician to approach the joint. After the femoral head isreplaced with a prosthetic femoral component, the greater trochanter canbe relocated and fastened in place. Existing methods for reattachment ofthe greater trochanter include the use of U-bolts, bolts, clamps, platesand screws.

While these methods work for their intended purpose, there remains aneed for improved apparatus and methods to apply compressive force to abone, such as the greater trochanter, across a fracture or otherresected area to maintain alignment and assist healing. Further, thereis a need for apparatus and methods that are easy to useintraoperatively to accommodate various bone sizes or shapes, orlocations of bone fractures or resections.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

In one form, a method for trochanteric reattachment is provided inaccordance with various aspects of the present teachings. The method caninclude positioning a femoral prosthesis relative to a proximal portionof a femur. A first portion of a self-locking adjustable flexible memberconstruct can be coupled to a first attachment region of the femoralprosthesis, and a second portion of the self-locking adjustable flexiblemember construct can be coupled to a second attachment region of thefemoral prosthesis, where the second portion can be opposite the firstportion. A trochanter can be positioned relative to the femur and atrochanteric engaging region of the femoral prosthesis, and theself-locking adjustable flexible member construct can be positionedaround an outer surface of the greater trochanter. Free ends of theself-locking adjustable flexible member construct can be tensioned todraw the trochanter into secure engagement with the femoral prosthesisand the femur via the self-locking adjustable flexible member constructin an absence of a knot.

In another form, a method for trochanteric reattachment is provided inaccordance with various aspects of the present teachings. The method caninclude positioning a femoral prosthesis relative to a proximal portionof a femur. First and second bores can be formed spaced apart from eachother and through a greater trochanter that has been at least partiallyseparated from the femur. A first portion of a self-locking adjustableflexible member construct can be passed through the first bore, and thefirst portion can be coupled to a first attachment region of the femoralprosthesis. A second portion of the self-locking flexible memberconstruct can be passed through the second bore, and the second portioncan be coupled to a second attachment region of the femoral prosthesisopposite of the first attachment region. The self-locking adjustableflexible member construct can be positioned around an outer surface ofthe greater trochanter. Free ends of the self-locking adjustableflexible member construct can be tensioned to draw the greatertrochanter into secure engagement with the femoral prosthesis and thefemur via the self-locking adjustable flexible member construct in anabsence of a knot.

In yet another form, a method for trochanteric reattachment is providedin accordance with various aspects of the present teachings. The methodcan include positioning a femoral prosthesis relative to a proximalportion of a femur, where the prosthesis can include first and secondattachment regions each having a plurality of attachment members spacedapart from each other and arranged at increasing distances from aproximal end of the prosthesis toward a distal end. The first and secondattachment regions can be on opposite sides of the femoral prosthesis. Afirst portion of a first self-locking adjustable flexible memberconstruct can be coupled to a first attachment member of the firstattachment region, and a second portion of the first self-lockingadjustable flexible member construct can be coupled to a secondattachment member of the second attachment region. A first portion of asecond self-locking adjustable flexible member construct can be coupledto a third attachment member of the first attachment region, and asecond portion of the second self-locking adjustable flexible memberconstruct can be coupled to a fourth attachment member of the secondattachment region. The first and second self-locking adjustable flexiblemember constructs can be positioned around an outer surface of thegreater trochanter such that the first and second self-lockingadjustable flexible member constructs overlap each other. Free ends ofthe first and second self-locking adjustable flexible member constructscan be tensioned to draw the greater trochanter into secure engagementwith the femoral prosthesis and the femur via the self-lockingadjustable flexible member construct in an absence of a knot.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The present teachings will become more fully understood from thedetailed description, the appended claims and the following drawings.The drawings are for illustrative purposes only of selected embodimentsand not all possible limitations, and are not intended to limit thescope of the present disclosure.

FIG. 1 is a partial view of the bones of an exemplary hip joint, where aproximal portion of the femur and a portion of the surrounding softtissue have been resected and replaced with an exemplary femoral hipprosthesis in accordance with the teachings of the present disclosure;

FIG. 2 is a partial view of the exemplary femoral prosthesis of FIG. 1having an attachment region in accordance with the teachings of thepresent disclosure;

FIGS. 3-6 are views of exemplary adjustable flexible member constructshaving optional fasteners coupled thereto in accordance with theteachings of the present disclosure; and

FIGS. 7-16 are various views depicting exemplary techniques fortrochanteric reattachment using the various adjustable flexible memberconstructs of FIGS. 3-6 in accordance with the teachings of the presentdisclosure.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, its application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.Although the following discussion is related generally to reattachmentof the greater trochanter of a femur, it should be appreciated that themethod and apparatus discussed herein can be applied to other bonesand/or areas of the anatomy including, for example, the greatertrochanter of a humerus of a shoulder joint.

Exemplary embodiments are provided so that this disclosure will bethorough, and will fully convey the scope to those who are skilled inthe art. Numerous specific details are set forth such as examples ofspecific components, devices, systems and/or methods, to provide athorough understanding of exemplary embodiments of the presentdisclosure. It will be apparent to those skilled in the art thatspecific details need not be employed, that exemplary embodiments may beembodied in many different forms and that neither should be construed tolimit the scope of the disclosure. In some exemplary embodiments,well-known processes, well-known device structures, and well-knowntechnologies are not described in detail.

With initial reference to FIGS. 1 and 2, an exemplary proximal femoralprosthesis 10 is shown for use in replacing a portion of the proximalfemur 14 in a hip joint 18. As will be discussed in greater detailbelow, femoral prosthesis 10 can be used for reattachment of greatertrochanter 22 that has been fractured, separated, and/or resected duringa hip reconstruction procedure.

In the exemplary configuration illustrated, femoral prosthesis 10 caninclude a proximal body 26 having a trochanteric engaging region 30 anda trochanteric attachment region 34. A tapered neck portion 38 canextend from the proximal body 26 and can be configured to mate with afemoral head 42. After implantation, femoral head 42 can be configuredto mate with an implanted acetabular prosthesis 46, as shown in FIG. 1.A distal end 50 of the proximal body 26 can include a female bore 54configured to mate with a corresponding proximal extension 58 of adistal stem 62. In one exemplary configuration, the proximal body 26 canbe interconnected to the distal stem 62 via a Morse taper connection 66.

The femoral prosthesis 10 can be provided in the modular configurationdiscussed above where various sizes of the proximal body 26 can beinterconnected to various sizes of distal stems 62 based on a particularsize and/or configuration of a patient's anatomy. It should beappreciated, however, that femoral prosthesis 10 can be also be providedin a unitary configuration.

The trochanteric attachment region 34 can include a flanged region 74 onfirst and second sides 78, 82 of a proximal end 86 of the proximal body26, as shown in FIGS. 1 and 2 with reference to FIG. 8. The flangedregions 74 can include a plurality of discrete attachment areas, such asapertures 90, configured to receive adjustable flexible memberconstructs for securing the separated greater trochanter 22, as will bediscussed in greater detail below. It should be appreciated that whilefour apertures 90 are shown in the flanged regions 74, more or lessapertures can be provided in proximal body 26 as may be desired fordifferent applications and/or anatomical sizes. In this regard, and aswill be discussed below, flanged regions 74 can also be provided withalternative attachment configurations, such as projections or tabs 104(FIGS. 14 and 15) that can be provided in addition to or in lieu ofapertures 90.

The proximal body 26 can be provided with a through hole 106 (FIG. 2)and a roughened or porous metal coating 108 to enhance biologic fixationand boney ingrowth, such as a layer of Regenerex® porous titaniumconstruct or a layer of PPS® Porous Plasma Spray, available from BiometManufacturing Corp., having a place of business in Warsaw, Ind. In oneexemplary configuration, components of the femoral prosthesis 10 caninclude those associated with the Mallory-Head Modular Calcar RevisionSystem™ also available from Biomet Manufacturing Corp.

With additional reference to FIGS. 3-6, various adjustable flexiblemember constructs 110 are shown that can be associated with proximalbody 26 for use in reattachment of greater trochanter 22. Withparticular reference to FIG. 3, a preformed adjustable self-lockingflexible member construct 110A is provided according to the presentteachings and can include a braided flexible member or suture 114 havinga first end 118 and a second end 122. Flexible member 114 can include abody 126 that defines a longitudinal passage portion 130 therein betweenfirst and second ends 118, 122. The passage portion 130 can define apair of apertures 134, 138 at opposed ends thereof.

To form construct 110A, the first end 118 can be passed through aperture134 and passage portion 130 and out aperture 138 such that a portion 146of flexible member 114 following first end 118 extends through passageportion 130. In a similar manner, second end 122 can be passed throughaperture 138 and passage portion 130 and out aperture 134 such that aportion 150 of flexible member 114 following second end 122 also extendsthrough passage portion 130. This configuration can form two loops 154and 154′, as shown in FIG. 3. It should be appreciated that whilepassage portion 130 is shown having two apertures or openings 134, 138,passage portion 130 can have additional openings and/or can includeadditional passage portions.

Adjustable flexible member construct 110A can include a pair ofcollapsible tubes or flexible anchors 160, as also shown in FIG. 3. Oneflexible anchor 160 can be coupled to loop 154 and the other flexibleanchor 160 can be coupled to loop 154′, as will be discussed below ingreater detail. Flexible anchor 160 can be an elongate member having asleeve or tubular configuration with first and second ends 168, 172 andan internal passage 176 extending therebetween, as shown in FIG. 3A. Theflexible anchor 160 can be made of resorbable or non-resorbablematerials, including braided suture, sponges and sponge-like materialsin solid form, perforated materials, woven/braided from biocompatiblematerials or fibers, such as, for example, polymer, polyester,polyethylene, cotton, silk, or other natural or synthetic materials.

The flexible anchor 160 can have any properties that allow the flexibleanchor 160 to change shape. In this regard, the flexible anchor 160 canbe, for example, compliant, flexible, foldable, squashable, squeezable,deformable, limp, flaccid, elastic, low-modulus, soft, spongy orperforated, or have any other characteristic property that allows it tochange shape. In some aspects, the flexible anchor 160 can be coatedwith biological or biocompatible coatings, and also can be soaked inplatelets and other biologics, which can be easily absorbed by theflexible anchor 160. In one exemplary configuration, the flexible anchor160 can be formed from a strand of No. 5 braided polyester suture. Inother words, multiple fibers can be braided together to form a hollowbraided flexible member having an internal passage.

As shown for example in FIG. 3A, flexible member 114 can be passedthrough a first opening 174 in a wall of the flexible anchor 160, guidedinto and along the internal passage 176, and passed out of the internalpassage 176 through a second opening 178 in a wall of the flexibleanchor 160 to associate flexible anchor 160 with loops 154, 154′. Theopenings 174, 178 can be positioned intermediately between the first andsecond ends 168, 172 of the flexible anchor 160 at a distance of, forexample, one-quarter length from ends 168, 172. It will be appreciatedthat the openings 174, 178 can be apertures or voids in the woven fabricof the flexible anchor 160, such that the openings 174, 178 do notdisrupt or break the weave of the flexible anchor 160 when made ofbraided or woven material. Further, portions of the flexible anchor 160between the first and second ends 168, 172 and the corresponding firstand second openings 174, 178, can define anchoring leg or tail portions190 that can provide additional resistance for securing the flexibleanchor 160 relative to a bone, fastener or implant, as will be discussedin greater detail herein. In one exemplary configuration, flexiblemember 114 can pass only through openings 174, 178 and a portion of theinternal passage 176 extending therebetween to form a loop that does notextend through tail portions 190.

The pulling or tensioning of ends 118, 122 of flexible member construct110A can cause reciprocal movement of portions 146, 150 relative topassage portion 130, and the loops 154, 154′ can be reduced to a desiredsize and/or placed in a desired tension. Tension in loops 154, 154′ cancause the body 126 defining the passage portion 130 to be placed intension and therefore cause passage portion 130 to constrict aboutportions 146, 150 passed therethrough. This constriction reduces thediameter of passage portion 130, thus forming a mechanical interfacebetween the exterior surfaces of portions 146, 150 and an interiorsurface of passage portion 130. This constriction results in staticfriction between the interior and exterior surfaces at the mechanicalinterface, causing the adjustable flexible member construct 110A to“automatically” lock in a reduced size or diameter configuration inwhich tension is maintained without use of a knot.

With reference to FIGS. 4A and 4B and continuing reference to FIGS. 3Aand 3B, an alternative preformed adjustable self-locking flexible memberconstruct 110B is shown. Construct 110B can be preformed to include adouble loop configuration having two loops 204, 204′ that each traversea path from one end of passage portion 130 to the other end thereof,instead of each loop being disposed at respective opposite ends ofpassage portion 130 as in construct 110A. Flexible member construct 110Bcan be formed by passing the first end 118 of the flexible memberthrough aperture 138, through passage portion 130 and out aperture 134.The second end 122 can be passed through aperture 134, through thepassage portion 130 and out the aperture 138. In various aspects, thefirst and second apertures 134, 138 can be formed during the braidingprocess as loose portions between pairs of fibers defining the flexiblemember 114, as discussed above.

Passing ends 118, 122 through the apertures 134, 138 can form the loops204, 204′. The loops 204, 204′ can define mount or summit portions 208,208′ of the adjustable flexible member construct 110B and can bedisposed generally opposite from the passage portion 130. Adjustableflexible member construct 110B can also include a pair of flexibleanchors 160, as shown in FIGS. 4A and 4B. With reference to FIG. 4A, oneflexible anchor 160 can be coupled to the summit portions 208, 208′ ofloops 204, 204′ such that both loops 204, 204′ extend through therespective flexible anchor 160 in a similar manner as discussed abovewith respect to flexible member construct 110A. The other flexibleanchor 160 can be coupled to passage portion 130 such that passageportion 130 extends through the flexible anchor 160 in a similar manneras discussed above. With reference to FIG. 4B, adjustable flexiblemember construct 110B can alternatively include flexible anchors 160coupled to loops 204, 204′ at opposite sides 214, 218 of passage portion130.

The longitudinal and parallel placement of the first and second ends 118and 122 of the flexible member 114 within the passage portion 130resists the reverse relative movement of the first and second portions146, 150 of the flexible member construct 110B once it is tightened. Thetensioning of the ends 118 and 122 can cause reciprocal movement of theportions 146, 150 relative to passage portion 130. Upon applying tensionto the first and second ends 118 and 122, the loops 204, 204′ can bereduced to a desired size or placed in a desired tension. Tension in theloops 204, 204′ can cause the body 126 of the flexible member 114defining the passage portion 130 to be placed in tension and thereforecause passage portion 130 to constrict about the portions 146, 150similarly to the constriction discussed above with respect to construct110A. This constriction can cause the adjustable flexible memberconstruct 110B to “automatically” lock in a reduced size or smallerdiameter configuration without the use of a knot.

Turning now to FIG. 5, an exemplary adjustable self-locking flexiblemember construct 110C is provided having only one loop 204. Adjustableflexible member construct 110C can be preformed in a similar manner asconstruct 110B, but with only one loop. Flexible member construct 110Ccan include a pair of flexible anchors 160 coupled thereto in a similarmanner as discussed above with reference to FIGS. 4A and 4B.

With additional reference to FIG. 6, an adjustable flexible memberconstruct 110D is provided according to various aspects of the presentteachings. The adjustable flexible member construct 110D can befashioned from flexible member 114 made of any biocompatible materialincluding, but not limited to, non-resorbable polymers, such aspolyethylene or polyester, resorbable polymers, and various combinationsthereof. In various aspects, the adjustable flexible member construct110D can include a hollow material or core to allow for appropriatetensioning, as will be discussed herein. In various aspects, theflexible member 114 can be hollow or a braided or a multiple-filamentbraided suture structure having a hollow core. In various aspects, thesuture can be resorbable.

The adjustable flexible member construct 110D can include a first end220, a first formed passage portion 224, a second end 228, a secondformed passage portion 232, and a fixed length loop portion 236connecting the first and second passage portions 224, 232, as shown inFIG. 6. In one exemplary aspect, flexible member construct 110D caninclude an elongated body 240 having an exterior surface and an interiorsurface defining an elongated passage between the first and second ends220, 228. The body 240 can define the first and second passage portions224, 232 and the fixed length portion 236 therebetween. Passage portions224, 232 can each include first apertures 244, 248 positioned proximateone end 252 thereof, and second apertures 256, 260 positioned proximatea second opposite end 264 thereof. The passage portions 224, 232 can beformed to have a larger width or diameter than remaining portions offlexible member 114, as shown for example in FIG. 6. Alternatively, thepassage portions 224, 232 can be formed initially to have the same widthor diameter as the remaining portions of flexible member 114, laterexpanding in diameter during the construction process. In variousaspects, the first and second apertures 244, 248, 256, 260 can be formedduring a braiding process of flexible member 114 as loose portionsbetween pairs of fibers defining flexible member 114, or can be formedduring the construction process. Alternatively, the first and secondends 220, 228 can be pushed between individual fibers of the braidedflexible member 114.

To form the adjustable flexible member construct 110D, first end 220 canbe passed through second passage portion 232 via first and secondapertures 248, 260, as generally shown in FIG. 6. In a similar manner,second end 228 can be passed through the first passage portion 224 viathe first and second apertures 244, 256, as also shown in FIG. 6.Subsequently, first end 220 can be passed through the first passageportion 224 via second and first apertures 256 and 244, respectively.First end 220 can follow a path that is opposite in direction to a pathfollowed by a portion 272 of the flexible member 114 that has alreadypassed through first passage portion 224 while following second end 228through first and second apertures 244 and 256. Similarly, second end228 can be passed through the second passage portion 232 via second andfirst apertures 260 and 248, respectively. Second end 228 can follow apath that is opposite in direction to a path followed by a portion 276of the flexible member 114 that has already passed through secondpassage portion 232 while following first end 220 through first andsecond apertures 248 and 260. This results in portions 280, 284 offlexible member 114 being positioned parallel or substantially parallelto portions 272, 276 in passage portions 224, 232. Passing the first andsecond ends 220, 228 though passage portions 224, 232 as discussed aboveforms adjustable loops 288, 292, as shown in FIG. 6. The first andsecond ends can be passed through the same apertures in each passageportion 224, 232 or, alternatively, through separate apertures in eachpassage portion 224, 232.

The adjustable flexible member construct 110D can provide a doubleadjustable loop configuration via adjustable loops 288, 292 while alsoproviding portion 236, which can have a fixed length between the passageportions 224, 232. This configuration can be used, for example, tocouple a flexible anchor 160 to loops 288, 292 and couple fixed lengthportion 236 to flexible anchor 160 and/or another device.

Flexible member constructs 110A-110D also can be provided with anantibiotic and/or platelet concentrate coating to resist bacterialadhesion and/or promote healing. In this regard, flexible memberconstructs 110A-110D, can be pre-configured with such a coating or thecoating can be applied intraoperatively. Further, the surgeon can alsoapply the platelet coating to the fractured or resected area of thegreater trochanter 22 during the trochanteric reattachment procedure.

With additional reference to FIGS. 7-16, the use of flexible memberconstructs 110A-110D in various exemplary trochanteric reattachmentconfigurations and procedures will now be discussed. With initialreference to FIG. 7, proximal femoral prosthesis 10 is shown implantedin femur 14. A proximal portion of femur 14 has been resected and thegreater trochanter 22 has been separated, as discussed above and shownin FIG. 7 with reference to exemplary line 300. The greater trochanter22 has been separated along exemplary line 300, during a hipreconstruction procedure for example, and is shown repositioned orrelocated against femur 14 along line 300 and against the trochantericengaging region 30 of proximal body 26. Flexible member constructs110A-110D individually, or in various combinations with each otherand/or additional fixation devices, can be used to compress and securethe greater trochanter 22 to femur 14 and proximal body 26 to assisthealing, as will be discussed below. While the following discussioncontinues with reference to greater trochanter 22 of femur 14, it shouldbe appreciated that the techniques can also be applied to the greatertrochanter of the humerus in configurations similar to those shown inFIGS. 7-16.

With particular reference to FIGS. 7 and 8, a pair of adjustableflexible member constructs 110A are shown coupled to proximal body 26 tocompress and secure greater trochanter 22 to femur 14 and proximal body26. In the exemplary configuration illustrated, the flexible anchor 160coupled to loop 154 of construct 110A can be positioned through aperture90 of flanged region 74 on first side 78 from a lateral side 310 to amedial side 314. Flexible member construct 110A can then be wrappedaround an outer surface 318 of greater trochanter 22 and flexible anchor160 coupled to loop 154′ can be positioned though aperture 90 on secondside 82, as shown in FIG. 7 with reference to FIG. 8. As also shown,more than one flexible member construct 110A can be used, as may bedesired depending on particular aspects of the anatomy and/or procedurebeing performed.

In this configuration, flexible member constructs 110A extend aroundouter surface 318 without extending through greater trochanter 22 toreach apertures 90. In this regard, depending on a width 322 of thegreater trochanter 22 relative to a width 326 between a correspondingpair of apertures 90, the flexible anchors 160 may need to be positionedthrough apertures 90 before the greater trochanter 22 is relocatedagainst trochanteric engaging region 30 because the greater trochanter22 can cover access to apertures 90. For example, and with particularreference to FIG. 8, greater trochanter 22 is shown as having a width322 wider than the width 326 between apertures 90 such that greatertrochanter 22 can cover apertures 90 upon being relocated againstproximal femoral body 26.

The flexible member constructs 110A can be coupled to any of theapertures 90 in the flanged regions 74 in various patterns andconfigurations, as may be required depending on a patient's greatertrochanter geometry, as will be discussed below. In addition, variousother flexible member constructs 110B-110D can be used in addition toand/or in lieu of constructs 110A to secure the greater trochanter 22,as will also be discussed below.

With additional reference to FIG. 9, a bore 334 can be formed throughthe greater trochanter 22 in alignment with an aperture 90 selected toreceive one of the adjustable flexible member constructs 110. In theexemplary configuration illustrated, construct 110A is shown extendingthrough bore 334 and through aperture 90. Depending on the angle ofapproach chosen to align bore 334 with aperture 90, as well as the formof outer surface 318, bore 334 can extend through a portion or all of athickness 338 of greater trochanter 22. For example, bore 334 shown inFIG. 9 extends through a portion of the thickness 338 of greatertrochanter 22. In one exemplary aspect, bores 334 can be used when thegreater trochanter 22 remains partially attached to the femur 14 andaccess to apertures 90 can be limited. While FIG. 9 illustrates use ofone flexible member construct 110A, it should be appreciated thatmultiple flexible member constructs 110A-110D can be used with orwithout bores 334 having varying lengths relative to thickness 338 ofgreater trochanter 22.

In the configurations illustrated in FIGS. 7-9, the free ends 118, 122of each flexible member construct 110A coupled to proximal body 26 canthen be tensioned to reduce a size of loops 154, 154′ and compress thegreater trochanter 22 into a secured engagement with femur 14 andproximal body 26. The tail portions 190 of anchors 160 can engage asurface 346 of the flanged regions 74 adjacent the apertures to anchorthe loops 154, 154′ relative to the proximal body 26, as shown in FIGS.7-9. In one exemplary configuration, tail portions 190 as well as theentire anchor 160, can bunch together, collapse, expand and/or changeshape to a second shape, configuration or locking profile 350 to secureloops 154, 154′ to flanged regions 74. It should be appreciated thatflexible anchors 160, upon being anchored to an appropriate surface,such as surface 346 associated with apertures 90, permit the associatedflexible member loop to slide relative to the flexible anchor such thatthe loops can be reduced in size upon being tensioned. Flexibleconstruct 110A can automatically lock under tension, as discussed above,after which a portion of ends 118, 122 can be trimmed and removed. Thisconfiguration can compress the greater trochanter 22 along line 300 withminimal modification to the greater trochanter 22, as compared to otherprocedures or techniques using a trochanter bolt extending throughgreater trochanter 22.

With additional reference to FIG. 10, another exemplary technique forsecuring the greater trochanter 22 is shown in accordance with thepresent teachings. In this exemplary configuration, a bore 334 canextend through a partial thickness of the greater trochanter 22 (FIG. 9)or through an entire thickness, as shown in FIG. 10. Bore 334 can beformed in greater trochanter 22 relative to the apertures 90 selectedfor use with one of the adjustable flexible constructs 110A-110D. Inthis regard, it should be appreciated that while bore 334 is shown inFIG. 10 relative to the first side 78 of proximal body 26, acorresponding bore 334 can formed in greater trochanter 22 relative tothe corresponding aperture 90 on the second side 82 (FIG. 8) of proximalbody 26. In one exemplary configuration, the pair of bores 334 andadjustable flexible member constructs shown in FIG. 10 relative to thefirst side 78 of proximal body 26 can be reproduced as a mirror imagerelative to the second side 82 of proximal body 26. As a result, thefollowing discussion will continue with reference to the first side 78,but will be understood to apply to the second side 82 as well, unlessotherwise indicated.

Once bores 334 are formed in greater trochanter 22 to align with theselected apertures 90, one of the adjustable flexible member constructs110A-110D, such as construct 110A shown in FIG. 10, can be used tosecure greater trochanter 22 to proximal body 26 via apertures 90. Inthe exemplary configuration illustrated, flexible anchor 160 coupled toloop 154 can be positioned through each bore 334 and correspondingaperture 90 in flanged region 74. Once flexible anchor 160 is positionedthrough aperture 90, the tail portions 190 can engage surface 346adjacent aperture 90 to secure loop 154 relative to proximal body 26 ina similar manner as discussed above. Free end 122 of each construct 110Acan also extend through apertures 90 while the opposite free end 118 aswell as loop 154′ can extend from the greater trochanter 22 relative toan opening 354 of bore 334 opposite flanged region 74, as also shown inFIG. 10.

The free ends 118, 122 of flexible member construct 110A can betensioned to reduce a size of the loops 154, 154′ in a manner similar tothat discussed above. Tensioning the free ends 118, 122 and reducing asize of loops 154, 154′ can seat each flexible anchor 160 relative tothe outer surface 318 and surface 346 of proximal body 26 and draw thegreater trochanter 22 into secured engagement with proximal body 26 andfemur 14, as shown in FIG. 10. It should be appreciated that while FIG.10 illustrates use of flexible member construct 110A, any of flexiblemember constructs 110A-110D can be used alone or in various combinationswith each other. In this regard, it should also be appreciated thatdifferent flexible member constructs could be used on the first andsecond sides 78, 82 of proximal body 26, as may be desired.

With additional reference to FIGS. 11 and 12, and reference back to FIG.8, adjustable flexible member constructs 110B and 110D are shown coupledto proximal body 26 to compress and secure greater trochanter 22 tofemur 14 and proximal body 26. With particular reference to FIG. 11,flexible member constructs 110B are shown coupled to apertures 90 andwrapping around outer surface 318 of greater trochanter 22 in a similarmanner as discussed above with reference to FIG. 7 and flexible memberconstruct 110A. In this illustrated configuration, free ends 118, 122can extend about the first and second sides of proximal body 26 as thepassage portion 130 and loops 204, 204′ of flexible member construct110B can extend around or relative to outer surface 318 of greatertrochanter 22.

In an alternative configuration where flexible anchors 160 are coupledto the passage portion 130 and summit portions 208, 208′, as shown inFIG. 4A, the passage portion 130 can be coupled to apertures 90, say onthe first side 78, and the summit portions can then be coupled toapertures 90 on the second side 82. In this configuration, the free ends118, 122 can extend from the respective apertures 90 relative to oneside of the proximal body 26 instead of relative to both the first andsecond sides 78, 82. In either configuration, the free ends 118, 122 canbe tensioned in the manner discussed above to draw greater trochanter 22into tight engagement with proximal body 26 and femur 14 to securegreater trochanter 22 thereto and promote healing.

As can be seen in FIG. 12 with reference back to FIGS. 6 and 8, flexiblemember construct 110D is shown coupled to proximal body 26 and securinggreater trochanter 22 thereto and to femur 14. In this configuration,one of the flexible anchors 160, such as flexible anchor 160 coupled toloops 288, 292 can be positioned through aperture 90 on first side 78and the other flexible anchor 160 coupled to fixed portion 236 can bepositioned through aperture 90 on second side 82. The free ends 220, 228can extend about a side of proximal body 26, such as the first side 78shown in FIG. 11, that includes the passage portions 224, 232 positionedrelative thereto. The free ends 220, 228 can be tensioned to reduce asize of loops 288, 292 and draw greater trochanter 22 into compressedengagement with proximal body 26 and femur 14 to secure greatertrochanter 22 relative thereto and promote healing. In a similar mannerto the other configurations discussed above, more than one flexiblemember construct 110D can be used and secured relative to apertures 90as may be required or desired by the physician.

With additional reference to FIG. 13 and reference back to FIG. 8, apair of flexible member constructs 110A are shown coupled to proximalbody 26 and securing greater trochanter 22 relative thereto and to femur14 in accordance with the present teachings. In this configuration, theflexible member constructs 110A can be secured to apertures 90 indifferent positions between the first and second sides 78, 82 ofproximal body 26 such that the second side 82 is not a mirror image ofthe first side 78. For ease of discussion, the flexible memberconstructs 110 in this configuration will be referred to as constructs110A′ and 110A″. In this exemplary configuration, the loop 154 ofconstruct 110A′ can be coupled to a third aperture 90C relative to theproximal end 86 of flanged region 74 on first side 78, as shown in FIG.13. Flexible member construct 110A′ can extend around outer surface 318of greater trochanter 22 and loop 154′ can be coupled to a firstaperture 90A relative to proximal end 86. In this configuration,flexible member construct 110A′ can extend around greater trochanter 22at an angle due to being positioned in first and third apertures 90A,90C that are positioned at different distances relative to proximal end86.

In a similar manner, flexible member construct 110A″ can be coupled toproximal body 26 such that loop 154 is coupled to a second aperture 90Bon first side 78 and loop 154′ can be coupled to a fourth aperture 90Don second side 82. Flexible member construct 110A″ can extend aroundouter surface of greater trochanter 22 such that a portion of flexibleconstruct 110A″ overlaps a portion of flexible construct 110A′ toprovide additional retention and securement of greater trochanter 22 toproximal body 26 and femur 14, as shown in FIG. 13. In the exemplaryconfiguration illustrated, flexible constructs 110A′ and 110A″ overlapeach other in a crisscross manner to form an X-shaped pattern. It shouldbe appreciated that while FIG. 13 illustrates use of two flexible memberconstructs 110A, other flexible member constructs can be used in variouscombinations to overlap each other in the manner discussed above.

Turning now to FIGS. 14 and 15 with reference back to FIGS. 3 and 4B,another exemplary configuration is shown for reattachment of greatertrochanter 22 in accordance with the present teachings. In thisconfiguration, proximal body 26 can include the plurality of projectionsor tabs 104 configured to removably receive a loop of one of flexiblemember constructs 110A-110D. The tabs 104 can be provided in addition toor in lieu of apertures 90. In one exemplary configuration, the tabs 104can extend from a surface 374 inboard from a perimeter edge 378 of thefirst and second sides 78, 82 of the flanged regions 74, as shown inFIG. 15. It should be appreciated that while a pair of tabs 104 is shownin FIGS. 14 and 15 associated with first and second sides 78, 82, moreor less tabs 104 can be provided on proximal body 26, as may berequired.

In this configuration, the loops of adjustable flexible memberconstructs 110A-110D can be removably positioned over the tabs 104 tocouple the loops to proximal body 26. In this regard, the flexibleanchors 160 are not necessary for use in coupling the flexible memberconstructs to proximal body 26. However, it should be appreciated thatthe flexible member constructs 110A-110D can be used with tabs 104 whilealso carrying the flexible anchors 160.

In the exemplary configuration illustrated, loop 154 of flexible memberconstruct 110A can be coupled to tab 104 on first side 78 and loop 154′can be coupled to tab 104 on second side 82 such that flexible memberconstruct 110A extends around outer surface 318 of greater trochanter22, as shown in FIGS. 14 and 15. Similarly, adjustable flexible memberconstruct 110B is shown have loops 204, 204′ on side 218 of passageportion 130 coupled to tab 104 on first side 78 and loops 204, 204′ onside 214 of passage portion 130 coupled to tab 104 on second side 82 ofproximal body 26. The free ends 118, 122 of flexible member constructs110A, 110B can be tensioned to reduce a size of the respective loops anddraw greater trochanter 22 into secure engagement with proximal body 26and femur 14 in a similar manner as discussed above. Again, it should beappreciated that other flexible member constructs can be used inaddition to, in lieu of, or in combination with constructs 110A and 110Band tabs 104 of proximal body 26. It should also be appreciated thatproximal body 26 with tabs 104 can be used with the various techniquesand configurations discussed herein in place of apertures 90 or incombination with apertures 90 to facilitate securing greater trochanter22 to proximal body 26 and femur 14 to promote healing.

Turning now to FIG. 16 and with reference back to FIG. 4A, anotherexemplary configuration is shown for reattachment of greater trochanter22 in accordance with the present teachings. In this configuration, anattachment device can be used in connection with the through bore 106 ofproximal body 26 to secure the greater trochanter 22 to femur 14 andproximal body 26. In one exemplary configuration, the attachment membercan include a medial plug 382 having a head 384 with an angled boneengaging surface 386 and a body portion 390 extending therefrom. Anattachment member, such as hook 394, can extend from an end of the bodyportion 390 opposite the head 284, as shown in FIG. 16. In one exemplaryconfiguration, the head 384 can include a larger diameter than adiameter of through bore 106, as also shown in FIG. 16. It should beappreciated that the medial plug 382 can include various attachmentmembers configured to receive one of the flexible member constructs110A-110D and can be provided with or without the head 384 having theangled bone engaging surface 386.

A bore 380 can be formed through greater trochanter 22 in alignment withthe through bore 106 of proximal body 26. A flexible member construct,such as construct 110B, can be coupled to the hook 394 at one end andcan be secured to outer surface 318 of greater trochanter 22 at anopposite end, as shown in FIG. 16. In one exemplary configuration, theflexible construct 110B of FIG. 4A can include one of the flexibleanchors 160 coupled to the summit regions 208, 208′, while the otherflexible anchor 160 coupled to passage portion 130 is not required. Withthis construct, the passage portion 130 can be passed through bores 380and 106 and coupled to the hook member 394. The flexible anchor 160 canbe positioned relative to outer surface 318 and the free ends 118, 122can be tensioned to secure greater trochanter 22 relative to proximalbody 26 and femur 14, as also shown in FIG. 16.

It should be appreciated that bore 380 can be formed at various anglesthrough greater trochanter 22 relative to bore 26, and that a pluralityof bores 380 can be formed for receiving a corresponding plurality offlexible member constructs. In addition, it should be appreciated thatthe greater trochanter 22 can be secured using medial plug 382 asdiscussed above along with various other techniques and flexible memberconstructs 110A-110D, including those discussed above in connection withFIGS. 7-15.

While one or more specific examples have been described and illustrated,it will be understood by those skilled in the art that various changesmay be made and equivalence may be substituted for elements thereofwithout departing from the scope of the present teachings as defined inthe claims. Furthermore, the mixing and matching of features, elementsand/or functions between various examples may be expressly contemplatedherein so that one skilled in the art would appreciate from the presentteachings that features, elements and/or functions of one example may beincorporated into another example as appropriate, unless describedotherwise above. Moreover, many modifications may be made to adapt aparticular situation or material to the present teachings withoutdeparting from the essential scope thereof.

What is claimed is:
 1. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a proximal portion of a first bone; coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the proximal portion of the first bone and a second bone engaging region of the prosthesis; coupling a second portion of the self-locking adjustable flexible member construct to the second bone portion; and tensioning free ends of the self-locking adjustable flexible member construct having a body that forms a passage, wherein tensioning free ends includes at least moving the free ends extending from the passage to cause the passage to constrict about portions of the self-locking adjustable flexible member construct due to caused tension, wherein tensioning further draws the second bone portion into secure engagement with the prosthesis and the first bone via the self-locking adjustable flexible member construct in an absence of a knot.
 2. The method of claim 1, wherein the first bone includes a femur and the second bone portion includes a greater trochanter of the femur.
 3. The method of claim 1, wherein the first bone includes a humerus and the second bone portion includes a greater trochanter of the humerus.
 4. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a proximal portion of a first bone; coupling a first portion of a self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the proximal portion of the first bone and a second bone engaging region of the prosthesis; coupling a second portion of the self-locking adjustable flexible member construct to the second bone portion; tensioning free ends of the self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the self-locking adjustable flexible member construct in an absence of a knot; and forming a bore through the second bone portion that has been at least partially separated from the first bone; wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes coupling the first portion of the self-locking adjustable flexible member construct to a plug member.
 5. The method of claim 4, wherein coupling the first portion of the self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes passing the first portion through the bore formed in the second bone portion and through a through bore in the first prosthesis, the medial plug configured to be at least partially received in the through bore of the prosthesis.
 6. The method of claim 5, wherein coupling a second portion of the self-locking adjustable flexible member construct to the second bone portion includes positioning a flexible anchor slidably coupled to the flexible member construct on an outer surface of the second bone portion adjacent the bore; and wherein tensioning free ends of the self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone includes tensioning the free ends to draw the medial plug into fixed engagement with a side of the through bore opposite a side facing the second bone.
 7. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a first bone portion; coupling a first portion of a first self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the first bone portion and a second bone engaging region of the prosthesis; coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion; and tensioning free ends of the first self-locking adjustable flexible member construct having a body that forms a passage, wherein tensioning free ends causes the passage to constrict about portions of the self-locking adjustable flexible member construct and draws the second bone portion into secure engagement with the prosthesis and the first bone via the first self-locking adjustable flexible member construct.
 8. The method of claim 7, wherein the first self-locking adjustable flexible member construct is a braided flexible suture.
 9. The method of claim 8, wherein tensioning the free ends of the first self-locking adjustable flexible member construct includes pulling on at least a first end of and a second end of the first self-locking adjustable flexible member construct that have both passed through a passage portion formed by the first self-locking adjustable flexible member construct.
 10. The method of claim 7, further comprising: forming a bore through the second bone portion that has been at least partially separated from the first bone; and wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes coupling the first portion of the first self-locking adjustable flexible member construct to a plug member.
 11. The method of claim 10, wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes passing the first portion through the bore formed in the second bone portion and through a through bore in the first prosthesis, the medial plug configured to be at least partially received in the through bore of the prosthesis.
 12. The method of claim 11, wherein coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion includes positioning a flexible anchor slidably coupled to the first self-locking adjustable flexible member construct on an outer surface of the second bone portion adjacent the bore; and wherein tensioning free ends of the first self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone includes tensioning the free ends to draw the medial plug into fixed engagement with a side of the through bore opposite a side facing the second bone.
 13. The method of claim 7, wherein the first bone includes a femur and the second bone portion includes a greater trochanter of the femur.
 14. The method of claim 7, further comprising: positioning at least the first self-locking adjustable flexible member construct around an outer surface of the second bone portion.
 15. The method of claim 7, further comprising: forming a bore in the second bone portion; wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes positioning a flexible anchor slidably coupled to the first self-locking adjustable flexible member adjacent an aperture define by the prosthesis; and wherein coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion includes positioning a flexible anchor slidably coupled to the first self-locking adjustable flexible member construct on an outer surface of the second bone portion adjacent a bore in the second bone portion.
 16. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a first bone portion; coupling a first portion of a first self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the first bone portion and a second bone engaging region of the prosthesis; coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion; tensioning free ends of the first self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the first self-locking adjustable flexible member construct; coupling a second self-locking adjustable flexible member construct to a third attachment region of the prosthesis; and positioning at least the first self-locking adjustable flexible member construct and the second self-locking adjustable flexible member construct around an outer surface of the second bone portion in an overlapping manner so as to form an X-shaped pattern with the first self-locking adjustable flexible member construct and the second self-locking adjustable flexible member construct.
 17. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a first bone portion; coupling a first portion of a first self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the first bone portion and a second bone engaging region of the prosthesis; coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion; and tensioning free ends of the first self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the first self-locking adjustable flexible member construct; wherein tensioning the free ends of the first self-locking adjustable flexible member construct includes pulling on at least a first end of and a second end of the first self-locking adjustable flexible member construct that have both passed through a passage portion formed by the first self-locking adjustable flexible member construct; wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes passing at least a portion of the first portion of the first self-locking adjustable flexible member construct through an aperture formed through the prosthesis and positioning a flexible anchor slidably coupled to the first self-locking relative to the prosthesis.
 18. The method of claim 17, further comprising: forming a bore through at least the second bone portion; wherein coupling the second portion of the first self-locking adjustable flexible member construct to the second bone portion including passing at least a portion of the second portion of the first self-locking adjustable flexible member construct through the formed bore.
 19. A method for reattachment of a bone, comprising: positioning a prosthesis relative to a first bone portion; coupling a first portion of a first self-locking adjustable flexible member construct to a first attachment region of the prosthesis; positioning a second bone portion relative to the first bone portion and a second bone engaging region of the prosthesis; coupling a second portion of the first self-locking adjustable flexible member construct to the second bone portion; and tensioning free ends of the first self-locking adjustable flexible member construct to draw the second bone portion into secure engagement with the prosthesis and the first bone via the first self-locking adjustable flexible member construct; wherein tensioning the free ends of the first self-locking adjustable flexible member construct includes pulling on at least a first end of and a second end of the first self-locking adjustable flexible member construct that have both passed through a passage portion formed by the first self-locking adjustable flexible member construct; wherein coupling the first portion of the first self-locking adjustable flexible member construct to the first attachment region of the prosthesis includes positioning the first portion of the first self-locking adjustable flexible member construct over at least one tab extending from the prosthesis. 